What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

scientificamerican.com

What's Behind the Fear of Vaccines?

10-13 minutos

Credit: BernardaSv Getty Images

Within medicine, few technologies have had more impact than

vaccines. Each year they prevent more than 3 million childhood
deaths worldwide from diphtheria, tetanus, pertussis and measles,
to name a few. Vaccines, such as those for HPV and Hepatitis B,
have extended those preventative benefits for young and mature
adults. And now a new generation of vaccines, ones that harness a
bodys immune system to treat disease rather than prevent it, are
moving through clinical trials and into the marketplace.

1 de 7 30/09/2017 11:44
What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

Yet for all their existing benefits and future potential, vaccines are
still bedeviled by problems of perception and adoption. Patients can
be suspicious of vaccines or confused by them, or they can fall into
complacency, believing that certain diseases are no longer a threat.
Regardless, the overall efficacy of vaccines is largely dependent on
coverage, so when coverage dwindles, outbreaks occur. Take for
example the recent measles outbreak in Minnesota, which began in
a community that was suspicious of vaccines. Vaccine hesitancy
also has a subtler and more insidious implication. It dampens the
appetite for new vaccines, stifling innovation and robbing patients of
better solutions.

We must help people better understand the enormous impact that

vaccines have on the health of the population and we must
continue to improve our ability to keep terrible diseases in check
through the use of this tool, says William Hearl, the CEO of
Immunomic Therapeutics, a clinical stage biotechnology company
that is developing its nucleic acid immunotherapy platform to treat
cancer, allergies and animal health issues. Immunomic has
developed what it calls LAMP-Vax technology (lysosomal-
associated membrane protein), which has the potential to improve
the efficacy of nucleic acid vaccines. And while a LAMP-based
vaccine based on Immunomics technology, which could treat
peanut allergies, could hit the market within the next couple of
years, Hearl says that vaccine hesitancy is an ever present concern
for all those working in his field.

In June, Scientific American Custom Media and Immunomic

convened some 40 scientists, policymakers and executives in
Washington, D.C. to discuss the promise of new vaccines, along
with threats to their development. Below are some of the major

2 de 7 30/09/2017 11:44
What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

takeaways from the evenings forum.

Looking Beyond the Roots of Fear

The first step to improve vaccine uptake is to address the fear that
prevents it. But that is more complex than it sounds. Its not like
people fear all vaccines for the same reasons. Throughout history, it
was common to believe that vaccines were violating Gods way or
perhaps violating the sanctuary of the body, says Arthur Allen,
author of Vaccine: The Controversial Story of Medicines Greatest
Lifesaver. For example, fears can arise from practical concerns,
say the modern vaccine schedule, which requires children to
receive up to 24 shots before the age of two. Or they can arise from
scientific or moral misgivings, as is the case with MMR and HPV.

Not only has the number and complexity of vaccines grown, and
with that the possibility of confusion and misperception, but patients
are left to sort through that information in an increasingly fractured
media environment. In an age of self-publishing and alternative
facts, anyone can go into that rabbit hole and grasp onto the bits of
information that fits into other aspects of their belief system, Allen
explains. The challenge, then, is to reach across those many
groups to address their fears directly. At the same time, healthcare
professionals need to ensure that those hesitant or simply
complacent about vaccines have access to them, and the incentive
to get them.

Acknowledging the Role of Information

For decades, the communication of reliable, accessible information

about vaccinesbacked with sound, scientific datahas been

3 de 7 30/09/2017 11:44
What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

central to the strategy of addressing fear and inspiring action. Yet

that strategy does not seem to be working as well as it once did.
Even with an increase in the amount of information sharedby
some counts up to four times morea national survey of
healthcare providers in 2009 found that 43% thought parents level
of concern had greatly increased while 28% thought it had
moderately increased compared with levels five years prior.

One solution could be a communications campaign targeted to

doctors. According to Phyllis Arthur, Managing Director of Infectious
Disease and Diagnostics Policy for the Biotechnology Innovation
Organization (BIO), Patients parents often cite the
recommendation of their health care provider as one of the most
important factors in their decision whether to vaccinate. Doctors
need to be incentivized to stand up for vaccineseven with
patients that might disagree. They also need to be told how to
communicate about them in a way that works.

More and more, communicators are relying on behavioral science

to ensure their messages are heard. For example, the Academy of
Pediatrics recently published a guide for pediatricians to discuss
vaccines with patients and parents, which emphasizes that
vaccines are rigorously tested, safety is continually monitored and
the risks associated with skipping or delaying vaccinesyet
challenges persist.

Arthur offers an example. What weve seen, historically, is that if a

physician walks in and says, youre going to receive the Hepatitis B
shot and the DTP vaccine, and you can also receive the HPV
vaccine, then theres an implication that one shot is more important
than another. A better approach would be stating, these are the
recommendations I make for your child or teen today and this is

4 de 7 30/09/2017 11:44
What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

why. Arthur adds that following up with a phrase like I had my own
children vaccinated or Ive had the vaccine can go a long way
when comforting parents or patients.

While such changes can seem nuanced, pursuing communication

without a strong methodological approach can actually do more
harm than good. A 2014 study, for example, found that when
parents who are hesitant about vaccines are given more
information, their concerns and misperceptions about vaccines
increased and they were less likely to immunize their children.

Brian Harvey, executive vice president of scientific and regulatory

affairs at the Global Liver Institute, agrees that sound scientific data
is key for relaying information and encourages the industry to find
creative ways to educate the general public with data. We need to
fundamentally change the way we share scientific information, he
explains. Most people arent looking to scientific journals for
information, but to Netflix and Hollywood. Its our job to educate the
folks in Hollywood, the television script writers, the Kardashians
and others who influence our culture with sound scientific evidence
so that they can share it accurately, he says.

Weighing Public Good Over Individual Interest

While communication is one lever to address vaccination coverage,

public policy is another. Lately, more and more states and countries
are pursuing public health policies that aim to increase vaccination
rates. Amid measles outbreaks, Italy earlier this year declared that
vaccines are mandatory for children as a condition of school
registration, and Germany announced it would penalize parents
with fines for not vaccinating children. Australias No Jab, No Pay

5 de 7 30/09/2017 11:44
What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

bill mandates that only parents of immunized children can receive

credits such as the Child Care Benefit, the Child Care Rebate and
the Family Tax Benefit. In the U.S., states like California, Vermont
and Washington have recently tightened requirements for using the
personal belief exemption, calling for medical exemptions from a
doctor for students to skip vaccinations.

This approach has worked. By and large, vaccine coverage

increases as mandates are put in place. That has some calling for
greater reliance on mandates as a way to short circuit the
shortcomings of communication. But Bruce Gellin, President,
Global Immunization for the Sabin Vaccine Institute in Washington,
D.C. and the former Deputy Assistant Secretary for Health and
Director for the National Vaccine Program, cautions against relying
too heavily on policy alone. It is a double-edged sword. Insisting on
a mandate can be polarizing, and were pretty polarized already,
he says. Mandates could, for example, work for a while but then
inspire a more robust anti-vaccination movement as individuals
fight for their right to choose.

Clearing the Path for a New Era of Vaccines

Despite immunization hesitancy, there will never be a lesser need

for vaccines, says Michael Vajdy, president of EpitoGenesis and
Director of Vaccines R&D Innovation at the Trudeau Institute. New
pathogens are constantly popping up and older pathogens are
changing surface proteins, he explains.

That is why vaccines are undergoing such a swift evolution. Among

the many approaches that scientists are exploring, DNA and RNA
vaccines are showing particular promise. When foreign DNA or

6 de 7 30/09/2017 11:44
What's Behind the Fear of Vaccines? about:reader?url=https://www.scientificamerican.com/custom-media/wha...

RNA is taken up by a cell and translated into a given antigen

protein, it elicits an immune response. If that antigen is associated
with cancer or HIV or some other chronic condition, you could train
the immune system, in essence, to treat it with a learned immune
response.

Immunomic Therapeutics investigational LAMP-Vax technology,

which was developed by Tom August at the John Hopkins
University School of Medicine, may improve the bodys immune
response to nucleic acid vaccines. It is believed that LAMP-Vax
diverts target antigens directly to a major histocompatibility complex
(MHC II) on antigen-presenting cells, such as dendritic cells, which
helps the immune system recognize foreign molecules. Its a very
direct way to teach the immune system about, say, an allergen,
virus or bacteria and to then tell the body to attack that molecule,
Hearl explains. In the past, during nucleic-based immunotherapy,
DNA could get lost in the shuffle. LAMP-Vax is designed to point it
in the right direction.

We started with a focus on allergies as a simple way to show that

we could activate the immune system with the LAMP platform, but
weve always had our eye on the oncology immunology space,
Hearl says. LAMP-Vax is currently being employed in Phase II
clinical trials as a cancer immunotherapy.

These new vaccines show an immense amount of promise,

although additional study is needed to confirm the benefits, Hearl
says. But to realize that promise, patients, regulators, and clinicians
need to recognize it first.

7 de 7 30/09/2017 11:44